How midwifery in B.C. went from maligned to mainstream

Shelley Fralic, Vancouver Sun05.13.2013

According to data compiled by the Midwives Association of B.C., there are close to 200 practising licensed midwives in the province (of the nearly 1,000 in Canada), and midwives assisted with 14 per cent of the 44,000 babies born in B.C. in 2010-2011, or about 6,000 of the total births.

It seems hard to believe, given that its practice is now embraced socially and politically, but there was a time not so long ago in B.C. when an expectant mother could not bring her midwife into a hospital.

It seems hard to believe, on this day following a collective celebration of mothers, that many doctors once openly and derisively discouraged an expectant mother from using a midwife, suggesting that she was foolishly putting her own life, and that of her baby, at risk.

But B.C. midwives continued ministering to new moms anyway, attending to the pre- and post-natal needs of a generation of women who were increasingly opting for a more natural birth experience, one that might even take place in their own home, one that didn’t involve invasive high-tech intervention, or decision-making that was too often out of their control.

Throughout the 1970s and 1980s, B.C. midwives and their clients, growing weary of their underground status and angry about the misinformation surrounding midwifery, launched a campaign to not only have the practice endorsed and regulated but also financially underwritten like other taxpayer-funded health choices.

Changing minds and attitudes takes time, but 20 years ago this week, at the International Confederation of Midwives Congress in Vancouver, the province finally succumbed to the pressure.

It announced it would begin the task of legalizing midwifery in B.C.

It took a few more years to work through the bureaucracy and, in 1998, the first B.C. midwives were registered under the aegis of the new regulatory College of Midwives of B.C.

Today, formally educated and accredited midwives throughout B.C. enjoy privileges at hospitals, and also practise in clinics and homes. According to data compiled by the Midwives Association of B.C., there are close to 200 practising licensed midwives in the province (of the nearly 1,000 in Canada), and midwives assisted with 14 per cent of the 44,000 babies born in B.C. in 2010-2011, or about 6,000 of the total births.

The change of bureaucratic and political heart was never more evident than when once-reluctant B.C. politicians decided in 2012 to fund the expansion of the four-year UBC Midwifery Program to 20 spaces from 10, and to provide $500,000 in additional funding to increase the number of home births.

Ganga Jolicoeur remembers the bad old days when the ancient profession of midwifery was deemed by the mostly male-dominated modern medical establishment to be little more than folk medicine, a viewpoint that resulted in constrictive legislation and even outright banning of the practice in the U.S. and Canada.

But the MABC executive director notes that great strides have been made in B.C. in relatively short order since that landmark decision a mere two decades ago.

“We’re beyond the point that we need to fight to be noticed by the system,” says Jolicoeur. “It is now an accepted normal part of the conversation around maternity care in our province.”

Not that midwifery advocates have abandoned the crusade.

Given that about 75 per cent of all births are considered “normal,” which is to say without serious complications for mother or child, Jolicoeur and the MABC have their sights set on raising the bar even higher.

She cites for inspiration countries like the U.K., New Zealand and Australia, where midwifery is now so integrated into the medical mainstream that 70 to 80 per cent of births in those nations involve midwives.

The goal for B.C.? “We are aiming for 35 per cent of the births by 2020, 2021.”

Jolicoeur also notes that the increasing societal support for midwifery isn’t just about women seeking a more homeopathic approach to their obstetric care, or wanting childbirth to be treated like the intimate natural biological process it is instead — rather than an illness that warrants the intervention of lab coats and intravenous drips. It’s also about providing sanctioned, safe and funded maternity care in remote rural and aboriginal communities that are woefully under-represented when it comes to health care.

No one’s saying that midwives should, or could, replace medical doctors, whose job it is to pick up the pieces when natural turns unnatural. But if there ever was a time to invoke that overused feminist chestnut — the one that suggests, sometimes with little merit, that we’ve come a long way, baby — society’s about-face on acknowledging that moms should be the ones in charge of birthing their babies may well be it.

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How midwifery in B.C. went from maligned to mainstream

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